CCCDTD5 recommendations on the deprescribing of cognitive enhancers in dementia

Date

2022-01-31

Authors

Henri-Bhargava, Alexandre
Herrmann, Nathan
Ismail, Zahinoor
Collins, Rhonda
Desmarais, Philippe
Goodarzi, Zahra
Iaboni, Andrea
Kirkham, Julia
Massoud, Fadi
Moser, Andrea

Journal Title

Journal ISSN

Volume Title

Publisher

Alzheimer's & Dementia: Translational Research & Clinical Interventions

Abstract

Introduction Cognitive enhancers (ie, cholinesterase inhibitors and memantine) can provide symptomatic benefit for some individuals with dementia; however, there are circumstances in which the risks of continuing treatment may potentially outweigh benefits. The decision to deprescribe cognitive enhancers must consider each patient's preferences, treatment indications, current clinical status and symptoms, prognosis, and dementia type. Methods The 5th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) established a subcommittee of experts to review current evidence on the deprescribing of cognitive enhancers. The questions answered by this group included: When should cognitive enhancers be deprescribed in persons with dementia and mild cognitive impairment? How should cognitive enhancers be deprescribed? And, what clinical factors should be considered when deprescribing cognitive enhancers? Results Patient and care-partner preferences should be incorporated into all decisions to deprescribe cognitive enhancers. Cognitive enhancers should be discontinued in individuals without ongoing evidence of benefit or when the indication for cognitive enhancer use was inappropriate (eg, mild cognitive impairment). Deprescribing should occur gradually and cognitive enhancers should be reinitiated if patients’ cognition or function deteriorates. Cognitive enhancers should be continued in individuals whose neuropsychiatric symptoms improve in response to treatment. Clinicians should not deprescribe cognitive enhancers in individuals with significant neuropsychiatric symptoms until symptoms have stabilized. Conclusion CCCDTD5 deprescribing recommendations provide evidence-informed recommendations related to cognitive enhancer deprescribing that will facilitate shared decision making among patients, care partners, and clinicians.

Description

Keywords

cholinesterase inhibitor, memantine, cognitive enhancer, dementia, deprescribing, discontinuation

Citation

Herrmann, N, Ismail, Z, Collins, R, et al. CCCDTD5 recommendations on the deprescribing of cognitive enhancers in dementia. Alzheimer's & Dementia: Translational Research & Clinical Interventions 8(1) 2022; 8:e12099. https://doi.org/10.1002/trc2.12099